The theory behind care pathways is sound, but the reality will necessitate a change in employee mindsets and much closer collaboration across all parties involved, writes Suzanne Clarkson

Whether care pathways will be seen as a passing fador a gamechanger very much depends on whether all stakeholders – from employers, to consultants, insurers and wellbeing services providers – are prepared to embrace a new way of working: one that is based on a foundation of trust and transparency. To quote an African Proverb: ‘If you want to go fast, go alone. If you want to go far, go together’.

Care pathways promise a win-win for all: for the providers of group risk and healthcare – the potential for cost reduction through a reduction in claims: for employees – fast access to the most appropriate care, no more waiting over a week for a GP appointment; for the employer– happier, healthier employees; for the intermediary – the tools required to help clients design and realise strategic wellbeing goals.

For the government too, care pathways are well placed to help support the prevention goals recently announced by Health and Social Care Secretary Matt Hancock in a recent speech to the International Association of National Public Health Institutes. He said that the NHS will not be sustainable without a “radical shift” towards preventing disease and illness.

The Department of Health has also made it clear that employers have an important role in helping to reach people with healthy lifestyle messages and support.

In short, everything seems to be moving in the right direction. So where’s the rub? Basically, where employees understand that wellbeing services are there and available – and that shouldn’t be taken as read – why they’d choose them over the NHS isn’t necessarily clear.

Then there is the problem that employers, intermediaries and providers are traditionally cagey about sharing data – data that would help pinpoint problems, reduce absence, improve individual and business outcomes.

Can care pathways make a meaningful difference in the absence of collaboration, trust and transparency? But before going further, what are care pathways? According to Aon principal Rachel Western, pathways in the UK follow two distinctive routes. “One is to speed up the access to treatment and the other is managing the patient journey through a clinically managed approach with specialist and provider networks,” she says.

The former could be described as open-door pathways, freely available to employees whenever they need them. For example, access to virtual GPs, telephonic or face to face counselling and on-demand physiotherapy.

Private medical insurance (PMI) providers have traditionally

leaned more towards the ‘directed’ or ‘managed’ approach, where an individual only accesses relevant services under the advice of the insurer’s case manager: usually a specialist nurse.

Who’s doing what?

Alongside this approach, most PMI providers now also offer a certain degree of open-door support too, especially in terms of GP services. For example, Bupa launched ‘Direct Access’, a telephone self- referral service, designed to help ensure early access to diagnosis and treatment for employees. “The majority of customers who are referred [via Direct Access] will see a specialist consultant within a week,” says at Bupa UK Insurance director of corporate Will Shaw.

Earlier this year, Bupa also partnered with Babylon to provide virtual healthcare services. “We believe this partnership empowers busy employees to seek medical support in a way that better fits their schedule,” adds Shaw.

This year also saw VitalityHealth relaunching a GP app in partnership with health tech company Square Health. The provider now ensures that every member – and uninsured members – on qualifying business policies, receive access to primary care as an inclusive benefit. “Today we have more primary care claims than musculoskeletal claims, which were historically our commonest type of claim,” says VitalityHealth clinical operations director Ali Hasan.

In April, Aviva gave its business members access to over 1,000 NHS doctors through an app deal with Now Healthcare. The provider also offers direct access to musculoskeletal care, and also mental health care. Aviva medical director Dr Doug Wright adds: “We see these types of service growing in the future.”

Cigna Europe, a pioneer of telehealth solutions, now offers a self-referral pathway for those with “emotional wellbeing concerns”. Cigna Europe CEO Phil Austin explains that via an open-access telephone assessment, employees are provided with advice, support and, where necessary, will be fast- tracked to appropriate treatment that is “generally accessible within 10 days”.

Axa PPP Healthcare has offered an open access pathway for musculoskeletal conditions for some time: traditionally, 40-50 per cent of the provider’s claims related to musculoskeletal problems. The insurer also offers a cancer pathway, in association with Check4Cancer. And although mental health makes up less than 5 per cent of claims, it also now offers a mental health pathway.

“This [mental health pathway] is more about fixing a system that’s broken and of value to clients,” says Axa PPP Healthcare head of corporate sales & marketing Nick Jeal.

The shift towards open door access sounds eminently sensible but, as Jeal concedes: “Pathways aren’t used as much as we’d like”. He adds: “The shift in mindset to call the insurer as opposed to your GP when you’ve got a problem is a big change.”

Why is usage low?

Indeed, at the moment it seems there’s a mismatch between what health and wellbeing services employers are providing and what employers want. Either that, or employers aren’t communicating what’s available and how to access it.

Health Shield head of product and marketing Jennie Doyle adds: “Feedback suggests that employers and employees don’t always understand why people would use such services over those offered by the NHS. There’s some confusion as to whether care pathways clash with NHS services.

“For this reason, it’s important that employers, in partnership with their intermediaries and providers, clearly communicate that essential services are available via the workplace, they’re there to be used, and that they complement the NHS and support the government’s push for prevention.”

There’s clearly a need for this kind of support in the workplace.

Health Shield’s research found that 90 per cent of people would feel better knowing there was a clear treatment pathway to

help manage a mental health or musculoskeletal issue. At the same time though, 7 in 10 said they don’t believe that employee wellbeing and musculoskeletal issues are taken seriously enough in the workplace.

This is somewhat surprising considering the array of benefits and services now offered in the workplace. It seems then the problem isn’t one of lack of provision: if a company has PMI,group IP or a health cash plan, chances are they have access to care pathways. Instead, the issue seems to be that these benefits and services are too siloed, reactive and immeasurable.

Perhaps companies simply need help to make better use of what they’ve got. But to do this requires data sharing – from employers to providers and across competing providers. And that brings us back to the collaboration, trust and transparency issue.

Intermediaries arguably have a role at every juncture in this particular pathway too.

It’s telling, therefore, that just 46 per cent of mid to large multinational companies based in the UK and Ireland say that clients manage health risks, effectively moving from ‘payer to partner’. Using data derived from PMI programmes, healthcare reporting is now available that provides detailed insights and recommendations to clients, helping them target specific areas of risk with impactful programmes and initiatives.

Meanwhile, Western would like to see “more mandating” of care pathways. “It’s still a light touch point for members but by making them more mandatory, it will allow the insurers to drive these efficient processes for members.”